8 Dental FluorosisDental fluorosis occurs as a result of long-term intake of fluoride during the period of tooth formationCharacterized by an increasing porosity of the surface and subsurface enamel causing the enamel to appear opaque

9 Etiological factors of dental fluorosisFluorides in drinking waterFluorides in foods and drinksFluoride ingestion period

13 The period of risk of developing dental fluorosisFor many years it was believed that only during certain stages of tooth formation can fluoride exert its toxic effect on enamel:the stage during which enamel is laid down by the ameloblasts

14 So long as a tooth has not yet eruptedinto the mouth,it may be sensitive toexposure to fluorideThe later in the pre-eruptive life ofa tooth that it is exposed to fluoridethe less severe will be the resultingdegree of dental fluorosis

16 Clinical features of dental fluorosisPermanent dentition:symmetrically distributed in the mouth, but not all teeth are equally affectedThe least affected teeth are the incisors and first permanent molarsThe premolars and other molars are most severely affected

21 Questionable (score: 0.5)The enamel discloses slight aberrations from the translucency of normal enamel, ranging from afew white flecks to occasional white spotsThis classification is utilized in those instance where a definite diagnosis of the mildest form of fluorosis is not warranted and a classification of “normal” not justified

22 Very mild (score: 1.0)Small, opaque, paper white areas scattered irregularly over the tooth but not involving as much as approximately 25% of the tooth surfaceFrequently included in the classification are teeth showing no more than about 1-2mm of white opacity at the tip of the summit of the cusps ofthe bicuspids of second molars

24 Mild (score: 2.0) The white opaque areas in the enamel of the teeth are more extensive but not involve as much as 50% of the tooth

25 Moderate (score: 3.0)All enamel surfaces of the teeth are affected, and surfaces subject to attrition show marked wearBrown stain is frequently a disfiguring feature

26 Severe (score: 4.0)All enamel surfaces are affected and hypoplasia is so marked that the general form of the tooth may be affected

27 The major diagnosis sign of this classification is the discrete or confluent pittingBrown stains are widespread and teeth often present a corroded-like appearance

28 The TF index--originally proposed by Thylstrup and Fejerskov--score 0-9--the TF index is a logical improvement andextension of Dean’s index--It is more precise and sensitive in itscharacterization of various degrees of severityof dental fluorosis, especially in its capacity todistinguish between the spectrum of changesassociated with the early signs and with themore severe forms of dental fluorosis

30 The shortcomings of several the above-mentioned methods -high initial cost of defluoridation plant-high operation and maintenance costs-low fluoride removal capacities-undesirable effects on water quality-generation of sludge-complicated procedures

31 The treatment of dental fluorosisFor very mild dental fluorosis:Physically grinding away the outer porous fluoroticenamel until the underlying almost sound andbetter mineralized enamel is exposed

32 Pronounced opacities and stains can be removed by alternatively applying phosphoric acid to enamel surface and polishing with an abrasive, finished by applying a mineralizing solution and topical fluorides to the treated enamel

33 In the cases of severe dental fluorosis:-Restoration with composite resinscosmetically unsatisfactory in the long run-Repair with crowns

87 Supernumerary teethTeeth that develop from accessory tooth buds The mesiodens is most commonly, a small cone-shaped tooth located between the maxillary central incisors Also, distomolars and premolars Treatment: None, unless for esthetic or occlusal interference

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